Critical Age Theory: Book Review

Published 29 May 2022.

I have been reading widely about aging since 2010.  

A few books take a comprehensive view of the aging process, titles that I often recommend to people who are not gerontologists so that they can get The Big Picture. 

Ten Books: An Essential Library on Aging

I have found another title to add to my list of must reads about aging. 

Mario D. Garrett, PhD has written a jeremiad of sorts about the many institutions that prey on older adults, capitalizing on the vulnerability many face in late life. 

To create a context, I suggest readers first watch the 2020 film, I Care A Lot, directed by J. Blakeson and starring Rosamund Pike. I watched the film the year it was released and found it interesting as an exaggeration, a dramatization of the state of eldercare in the 21st Century. 

Two years after viewing that film, Garrett's book has me rethinking I Care a Lot as being less a niche genre black satirical comedy thriller and more from the genre "based on true events."  I had already planned on mentioning this film in my review before I saw that Garrett references I Care A Lot (2020) himself.   

Watch the film, but if you going to choose one, read Garrett's book.  

Critical Age Theory: Profiteering From the Final Stages of Life (2022) describes the ways for-profit companies and even the government and non-profits fail older adults when they are the most frail of mind, body, and finances. 

I teach college courses on aging (gerontology), and this book would work well to alert my students to the unethical practices that are inherent in the system and challenging for individuals to change at their level. 

The chapters are as follows (with a staccato summary/response for each chapter). 

(Here is my Goodreads review, which I wrote chapter-by-chapter as I read. It's grittier than my blog review.) 

Introduction: This sets the tone with Garrett as the lone voice in the wilderness, asking people to look at the larger systems controlling aging and to spend less time blaming elders and their family caregivers and less time wagging fingers at those paid to offer support directly to older adults.  The problem goes higher up, and it goes deep into the structures of 21st century power structures.  Here is one example that gestures to system rather than the individual as the root problem:

"We make it easy for . . . commercial practices to continue as we tend to see only individuals that commit fraud or harm. As with elder abuse, we personalize the interaction. however, in most cases, the institutional make up--what we euphemistically refer to as their business model, or business culture--determines how individual workers behave within an agency. Since the business model dictates workers' hours, duties, and responsibilities, it is logical to examine the business model being used" (9). 

(I do not remember Garrett using the word "hegemony," but academics use this--and other words--to study the network of power that is pervasive and difficult to combat.)

1. Drugs: Drugs are often improperly prescribed and almost always overpriced.  

*Each chapter ends with a "Playbook" that unearths the game plan that seems to drive decisions based on profitability over patient-centered / customer-centered / client-centered service. One of the items from the "Playbook" on the chapter "Drugs" is this: "Price medications on the basis of what people can afford rather than what they cost to develop and manufacture" (37). 

     

Health Span Differs from Life Span

Photo by Quinn Dombroski.

Because I am a gerontologist, people often talk to me about their desire for longevity.

But is this wise?

I spent three years volunteering in a multi-level care center, observing the difference between lifespan (how long a person lives) and health span (how long a person lives without disability).

The all-too-human desire for longevity reminds me of the Greek myth of Tithonus.

He was a mortal who was the beloved of Eos, the Titan goddess of the dawn. She asked Zeus to bestow eternal life upon Tithonus. Zeus did so.

But Tithonus did not receive eternal youth. Instead, age transformed him into a grasshopper.

And that problem--immortality vs eternal youth--has been exaggerated in the 21st Century as people in industrialized nations are living several years longer than their great grandparents.

How We Age: Book Review

Published 1 February 2011.

I very much enjoyed reading How We Age: A Doctor's Journey into the Heart of Growing Old. (2011).

Dr. Marc E. Agronin graduated from Harvard and then Yale Medical school before becoming a psychiatrist at the Miami Jewish Health Systems.

Agronin possess a great blend of intellect, spirit and emotion as he moves from describing very specific incidents with patients to describing very general observations about the process of aging.

He combines viewpoints from the sciences, social sciences and the humanities while working with people in their 70s, 80s, 90s and 100s.

Agronin does focus a great deal on what he labels "The Four Horsemen of Old Age": depression, dementia, delirium, and destitution.

But his book is not all gloom and doom. He also describes older adults experiencing laughter, healing, restoration, intimacy, legacy, and insight in their final chapter of life.

Wrinkles: Film Review

Released 2012

Wrinkles (2012) is an 89 minute animated film that focuses on the friendship between Emilio and Miguel, roommates residing in the same multi-level care center.

Emilio is a family man and a retired banker--cautious and methodical.  Miguel is a free spirit, always looking out for number one.

Although a Spanish film originally, there is an English-language version.  Emilio is voiced by Martin Sheen, Miguel by George Coe.

The film also introduces a handful of supporting cast members, mainly those living and working in the same facility.

Yes, this is an animated film, but it shouldn't be mistaken for a children's story. It takes a fairly realistic approach to depicting the challenges some people face in late life.

Share Music Videos with Others

Photo by Steve. 

Once a week I spend the afternoon with a dozen friends at a local skilled nursing center.

Sometimes we have a lull in an activity we're doing together. 

When this happens, I always offer to sing as a way to fill the time. 

They howl, "No, don't do that."  

This week we were joking about our day being a stereotypical Monday.  One of the residents asked me if I knew the song "Monday. Monday," released in 1966.  

Again, I volunteered to sing. Olivia protested, "Nooooo!"  

Social Engagement through the Life Span

Karen at 52 and Gladys at 104.  Twice my age! 

Last week I had the good fortune of attending a birthday party for my friend Gladys Bever. She turned 104 years old.

She is very kind to accept visits from me each Monday.  She talks about growing up near Marysville, California where her father had an orchard.  She helped at home, painted, played the piano and was a good student.

I enjoy seeing the world through her eyes. Not only does she have decades of experience, she's positive, dedicated to her faith and intelligent. She has great eyesight still and reads about three books a week.

The Story of My Father

Published June 8, 2004

For the last four years, I have been trying to learn more about Alzheimer's Disease.  As a retired English teacher, I frequently have people ask me about age-related changed to cognition.

Of course, people should talk to a neurologist for an expert opinion. Nevertheless, I am trying to learn what I can so that I can point people to resources.

More and more I am seeing the value in dementia memoirs, written by caregivers.  Although published in 2004, I recently got my hands on a copy of The Story of My Father by Sue Miller.

The author describes her relationship with her father in general and her need to respond to his Alzheimer's Disease in particular.

Re-imagining Alz: Dancing with Rose

Published May 31, 2007.

No doubt, living with dementia is a challenge. Whether caused by Alzheimer's Disease, vascular dementia or another cognition-altering malady, memory problems make it difficult to function in the world, difficult to relate to others.

I have frequently heard caregivers recommend Lauren Kessler's book Dancing with Rose: Finding Life in the Land of Alzheimer's. I finally made the time to read her account of working in the memory care wing of a skilled nursing facility.

Trained as a university professor, Kessler decided to work a minimum-wage job as a certified nurse assistant (or resident assistant as she calls it). She chose to do this as a way to pay homage to her mother who spent her last few years living with dementia.

Adding Care to Senior Housing

Photo by Kotomi_.

In decades prior, older adults often lacked options for aging with support. Many either stayed too long in their own homes without adequate services, or they moved too soon  into a skilled nursing facility.

Older adults today have more options for where and how they age:

Types of Housing

• Long-established Home (with or without modifications for aging in place)
• Relative's Home
• Active Adult Community
• Senior Apartments (some are government subsidized)
• Independent Living Communities
• Assisted Living Communities
• Skilled Nursing Facilities
• Continuing Care Retirement Community (2 or more levels of care under one roof)

Or they might be in a temporary situation after an acute illness:

• Subacute "Step-down" Facility 
• Long-term Acute Care Hospital

Some of these choices might be unavailable or difficult to acquire due to constraints on finances, family availability, geographic location, health, or limited supply / vacancies.

Services Added to One of the Above Settings

Centenarians on the Rise in the US

Birthday party at the Kansas Masonic Home for Gladys Bever. 

Today I had the good fortune of attending a birthday party for Gladys Bever. At 103 years old, she remains fairly active.  She only just recently started using a walker. She's still very sharp. Her memory rivals that of people decades younger than she.

Gladys Bever, 103. 

Gladys enjoys reading books, primarily devotional literature.  She's one for whom the phrase "all that clean living" really applies while some other centenarians can hold onto some unhealthy habits. She focuses on the positive and shuns things that are contentious or frivolous.

I enjoy visiting with her each week. She tells me about many of her life adventures. We loan each other books.

She was born Gladys Oakley at home on July 30, 1910 in Yuba County near Marysville, California.  Gladys married H. Cecil Bever, who worked for decades as a preacher.

Gladys has performed hundreds of hours of church service in various states in the US and went on some service trips abroad, too. She has been an attentive mother for decades as well.

Movies Set in Nursing Homes

Photo by North Dakota National Guard. 

Most movies focus on the characters. Sometimes, however, the setting exerts considerable influence.

The setting looms large for many movies filmed in nursing homes, assisted living facilities or even active living retirement communities.

Often the conflict for movies with such settings stems from an environment populated primarily with people in late adulthood.

Below find a sampling of such movies, which mainly feature films but two documentaries as well.

Sundowning: Agitation in the Evening

Photo by Fr Antunes

I have to admit that I avoid visiting skilled nursing facilities (SNF) in the late afternoon and early evening. I have a handful of friends who live in SNFs, and I have observed a phenomenon called sundowning or sundowner’s syndrome, which affects a number of residents.  

People with Alzheimer's disease and other dementias are prone to experience confusion and agitation as the sun goes down, making it difficult to communicate with them and care for them.  For some reason, people in the mid-stages of dementia seem to be most affected.   Symptoms include the following: yelling, crying, confusion, hallucinations, tremors, and pacing. 

Missing Personal Items: Lost or Stolen?

Photo by Natalie Barletta

Over the last year, I have been making weekly visits to a skilled nursing center to check on one of my friends.  All too often, she tells me that she’s missing a personal item: lipstick, magazines, television remote, eye glasses, clothing, etc. 

Most upsetting was the loss of her new winter coat less than a week after she received it as a Christmas gift.  Most of these items were not marked with the owner's name. 

Because I am not there 24/7, I am not sure how these items go missing.  My friend has cognition problems, so I suspect that some of these items are merely misplaced.  Places I regularly check for items:

• In the bedding
• Under the bed, dresser, vanity or nightstand
• In the pocket of a sweater or coat
• In a purse that is seldom used
• On the floor of the closet
• Within the wheelchair in which she is sitting

Also, some of the other residents also have cognition problems, so they may pick them up innocently.   Also, some of the items never were marked with pen or engraved.  Staff members struggle to direct items to the correct resident if they are not marked.

Most unsettling is the possibility that items have been stolen—either by another resident who knowingly took them, by a visitor, by regular staff, or by one of the many visiting professionals.

Long-term Care Is More Probable as We Age

Photo by fairfaxcounty

Seventy percent of people 65 plus will use some form of long-term care.  This means that they will need help with ADLs and IADLs. These terms refer to activities of daily living such as dressing, eating, toileting or help with instrumental activities of daily living such as managing their medications, paying bills, and using a telephone.  

And with the Baby Boomers coming of age with increased longevity, the number of people requiring long-term care is projected to increase dramatically between 2020 and 2050. 

The type of long-term care an older adult receives may be short and provided by a family member. However, the older a person grows, the more likely he or she will need long-term care for longer periods of time. This may require some form of home health care or a period of stay in a skilled nursing center.   

Here are some statistics about long-term care:

• Nearly 70% of Americans over 65 will require some form of long-term care.

• Nearly 40% of Americans over 65 will spend some time in a nursing home.

• The average stay in a nursing home is 2.5 years.

• The average cost of a nursing home stay is about $70,000 a year.

ETA*: For additional pertinent numbers, see this 8/9/2012 news article by Christine Benz, which contains 40 separate statistics gleaned from caregiver organizations, government offices, and long-term care insurers. 

People pay for long-term care in a variety of ways: family caregivers, private long-term insurance, out-of-pocket spending, or Medicaid.  Note that Medicare does not provide significant long-term care.  For example, Medicare will provide at most 100 days of skilled nursing care (usually post-surgery). If people expect the government to pay for their long-term care, they will need to qualify for Medicaid, which requires that beneficiaries impoverish themselves first.

It's not quite evident how we will rise to the challenge of caring for older adults, but the topic is increasingly more prevalent in public discourse.  Do your part by staying informed on the issues related to aging, caregiving, long-term care, and government programs that support the frailest among our elders. 

ETA=Edited to Add

Related:

Activities of Daily Living and Instrumental Activities of Daily Living
More Seniors than Ever: Population Pyramids
Life Span (122) vs Life Expectancy (84). 

Activities of Daily Living and Instrumental Activities of Daily Living

Photo by Erich Ferdinand

While people of every age might have trouble with Activities of Daily Living (ADLs), I encounter this phrase or its acronym almost daily as applied to older adults, particularly those 85 plus. 

“Activities of daily living” is a phrase describes some of the basic tasks necessary for self-care such as eating, bathing, dressing, transferring, grooming, and continence.  ADLs are one of many areas for measuring a person’s overall wellness.

This phrase is used by social workers, health care workers, insurance companies, judges, assisted living administrators, and caregivers.   While the phrase is fairly widespread, various instruments for assessing ADLs yield different results for the same populations when applied. 

Coping with Illness

Photo by Judy Baxter

People of all ages and life situations are at risk for illness and injury.   But as we age we experience greater risk.  Whether the illness happens suddenly as with a fall or more slowly as with memory problems, the affected person and his or her family members must find methods for coping.

Course materials for the Nursing Learning Network identify the following tasks that ill people face:

1. Change in body image
2. Reality of their own mortality
3. Coping with altered relationships with others
4. Dealing with an altered level of dependency
5. Adjusting to physiological changes
6. Grieving for their losses, such as their former self or former lifestyle
7. Fear of recurrent problems
8. Illness occurs with other stressors, such as disrupted household routines, neglected or increased financial needs, and shifting workplace responsibilities

Label Clothing for Nursing Home Residents

Photo by Bruce Guenter

If a person has moved into a skilled nursing center--for a short stay post-surgery or as a permanent move--it means they are having trouble managing day-to-day tasks, including laundry.  

Residents can have family members do their laundry for them; however, many residents rely on the laundry services provided at the nursing home.  

It's important to label items clearly with a laundry pen or by affixing an iron-on or sew-on label. 

By checking a few online Q&A sites about labeling clothes for nursing home residents, kids going to summer camp, and children in daycare, I found this information:  

Permanent Markers (i.e., Sharpies). These are convenient, but they only last for about four washings.

Fabric Markers.   The ink lasts longer than permanent markers, but fabric markers are a little harder to find.  If your grocery store doesn't carry them, try a craft store or buy them online.

Iron-on Labels.   These are easy to apply if you know how to wield an iron, but these iron labels do not adhere well on some fabrics.  You can pay to have these printed or run them through your computer.

Sew-on Labels.  These are more expensive and more time consuming to sew on, but they are sturdier and have a longer life than marking with a permanent marker or a laundry pen.

Bingo--More Than Meets the Eye

Photo by Kimberly Malvar

Attending Monday bingo in the skilled nursing center for fifteen months has shown me that this supposedly simple game requires the players to manage multiple skills.

Players must have adequate vision, hearing and the fine or gross motor skills to play. 

During a round, someone asks, "Did the caller say '50' or '60'?" They also need the cognition to retain the number in their mind while scanning each number on three cards.

For reasons having to do with vision or with cognition, sometimes a 3 will look like an 8, a 7 like a 1. They also have to perceive the winning patterns.

Almost each resident in skilled nursing has trouble with at least one of these tasks, but they find ways to accommodate age-related changes.

Laura sits at the front table so that she can see each ball as it comes out of the mixer. She relies on her vision since her hearing is impaired. Sam uses large-print cards. Bill places his cards on a non-stick mat and wears gloves that keep his fingers from forming a fist. These aids help him push the windows closed without the assistance of a staff member or volunteer.

A handful of residents have every skill set required to play bingo. They just have lower-body challenges to manage, so once they maneuver their wheelchair into place, they are ready to play without impediment.

Betty receives gentle reminders from a volunteer about when she can call bingo. Even though she struggles to remember that five numbers in a row is the desired pattern, she shows great accuracy each week over the course of 11 games in finding the called numbers on her cards. Even though she has memory problems, she still possesses enough skill with her hearing to help others at her table.

Residents at tables throughout the dining room take turns helping each other in this way: one might have the better hearing, her neighbor the better vision. This co-operation reinforces the importance of social skills required for bingo. They tease each other for winning too often or not at all.

Gladys wins the current round, so she receives a dollar in winnings. The caller shouts out, “If there are no others, this round is closed. Clear your cards.” An adult son walks into the dining room and pulls a chair next to his father. Another resident comes in from an appointment in the beauty parlor and tries her luck for the last two games.

The weather outside worsens. Everyone looks up to see the rain splashing heavily against the windows before turning to hail. The noise of the storm mixes with the sound of the bingo balls tumbling in the cage. One by one, the numbered balls escape down the shoot and line up to be called in the next game.

Related:

Is It Dementia or Only Delirium?
Age-related Changes to How We Write
Activities of Daily Living and Instrumental Activities of Daily Living
Don't Be a Boy Scout: Preserving the Independence of Older Adults